Medicare claims don’t always follow a straight path—from submission to payment, they often twist through edits, rejections, denials, and appeals. Understanding the Medicare claim guidelines is essential to protect revenue and reduce costly delays. This webinar takes you step by step through the process of a Medicare Part A and Part B claim, revealing what happens behind the scenes once a claim is submitted. This webinar will unpack common roadblocks, explain why claims derail, and show how to navigate each stage with confidence. Participants will learn how claims are processed, where errors commonly occur, and what actions to take when claims are denied or underpaid. Whether you’re new to Medicare billing or looking to refine your claims management strategy, this session will help you untangle the complexities of the Medicare claims process and guide your claims toward successful reimbursement.

What You’ll Learn:

• Medicare Guidelines for Claim Submission
  – Mandatory billing
  – Non-Participating
  – Opt-out professional
  – Timely filing
• How to File
  -Paper Claim Submission
  – DDE Claim Submission
  – SNAP Claim Submission
  – EMC Batches
• Claim Entry
  – Paper Claim
  – Electronic File Submission
• Online Adjudication
  – System Edits
  – FISS Online Adjudication
  – Common Status/Location
  – MCS Online Adjudication
  – Additional Development Request
  – Rejection or Denial
  – Common Working File
  – Health Integrated General Ledger Accounting System (HIGLAS)
  – Payment Floor
• Finalization- Payment Ceiling
  – Post Adjudication Review and Adjustment

Who Should Attend:

• Physicians
• Non-Physicians Providers
• Medical Billing Specialists and Managers
• Medical Coding Specialists and Managers
• Medical Auditors
• Revenue Cycle Manager and Staff
• Practice Managers
• Claim Reviewers
• Office Managers and Administrators
• Clinical Operations Staff
• Compliance Officers
• Qualified Healthcare Practitioners
• Healthcare Executives, Directors and Supervisors

Don’t miss this opportunity to master the Medicare rules and guidelines for claim processing to avoid the denial or rejection and speed up reimbursement.